Throughout our journey together, we struggled to hone the art of having musical conversations. With no score to follow, we drew on what we had learned and practiced — and made up the rest as we went along. There were moments of uncertainty, self-doubt and discomfort, as well as many moments of laughter, connection and creativity.

My self confidence and musical skills slowly grew, but the lessons I learned extended far beyond the walls of the drumming studio. Throughout this journey, I’ve been thinking more and more about improvisation in relation to my life outside the drumming class and, in particular, to my work as a social worker and educator.

As many before me have noted, clinical encounters are acts of “relational improvisation” as they are comprised of unfolding dialogues into often unknown territory. We can’t know where the conversation will go as we try to negotiate meaning together.

While these interactions happen without the safety net of a script, clinicians do not arrive empty-handed: we draw on our experience, knowledge and practice skills to forge connections with (virtual) strangers – or patients – who are coping with life crises, illness, or loss.

This improvisational dynamic resonates powerfully with musicians as well. As Kenneth Sharpe points out in his discussion of jazz music and moral improvisation in healthcare, practitioners

are not just “making it up,” any more than a good jazz musician is making up music. Moral medical practice starts with ethical guidelines and professional norms. But these rarely tell precisely what to do… Good improvisation is not making something out of nothing, but making something out of previous experience, practice, and knowledge.

In the blog post how-jazz-helps-doctors-listen, violinist and medical educator Stephen Nachmanovitch underscores the importance of “presence” in both musical and clinical encounters. What he says applies to jazz musicians playing in an ensemble as well as front line practitioners and therapists facing a client or patient:

In real medicine, you view the person [the patient] as unique. You use your training, but you don’t allow your training to blind you to the actual person sitting in front of you [or alongside you in a band]. In this way, you pass beyond competence to presence. To do anything artistically, you have to acquire technique, but you create through your technique, not with it.

On a more personal level, relational drumming class taught me a lot about where the edges of my own comfort zone are in relation to risk-taking, vulnerability, and venturing into the unknown. It taught me how hard it is to be in relationship with others when our “internalized voices” (the sometimes negative stories we tell ourselves about ourselves and others) threaten to drown out what’s in front of us, and reduce our ability to respond to what is unfolding at that moment.

Drumming class also taught me about the importance of “showing up” and sticking with it – especially when things go off track because of faulty listening or poor communication. I learned it’s about making a contribution that will serve the larger group (i.e. think about the needs of the “circle” or the community), and it’s about geting back on track when you misstep.

In jazz, every mistake is an opportunity… many actions are perceived as mistakes only because we don’t react to them appropriately. Mistakes only come from lack of awareness and attention… jazz is about the science of listening.

Being in an improvisational class provides a perfect opportunity to think about the balance between personal self expression and the needs of the larger group. As a student of relational improvisation I learned something about the delicate (and always shifting) balance between finding one’s own voice and honoring the voices of others. Relational improvisation is about cultivating the courage to express one’s self, but it’s not only about self expression; it’s also about leaving room for the contributions of others. These attempts to create collaborative conversations are as tricky in relational improv class as they are in clinical and therapeutic encounters!

In his discussion of communication in the clinical encounter, medical educator Paul Haidet points out that improvisational practices are the foundation of collaborative clinical relationships; and that the skills learned in musical improvisation can be a powerful resource for learning to engage patients in collaborative conversations. Paying attention, adapting, and being comfortable with not knowing are necessary (while often neglected) skills for managing day-to-day practice:

Patient-centered care demands leaving space for patients to organize their unique narratives. Figuring out when and how to interrupt, to slow down, to be silent, to change the subject — these are the kinds of improvisation a jazz player makes all the time.

Paying attention to those dynamics in drumming class gave me some ‘ah ha’ moments about how I negotiate those tensions in my social work practice. I thought about how much space I’m comfortable leaving in difficult and delicate conversations, how I feel when I don’t know how to respond to something, what situations prompt me to become more directive (and less collaborative), what I decide to focus on and amplify when someone has many issues – and what I decide to leave behind.

One of the main things I carry away from my lessons in relational improvisation is that our practice is richer, and more interesting, when we create something together. This brings me to key principles in theatre improvisation — shared responsibility, cooperation, and communication. The notion of “yes, and” captures this open and collaborative spirit. As described in 10-principles-of-improv-and-why-you-should-care:

“Yes, and” means that we accept everything that happens as an offer, as a gift. It is our job to bring our unique perspective to bear, and build off of whatever is given to us.

‘Building off whatever is given to us’ seems a powerful metaphor for practice. While not ignoring the skills and knowledge that practitioners bring to clinical encounters, it acknowledges the unpredictable nature of the process and firmly locates our attention in what we construct together. It also acknowledges the interpersonal sensitivity and creativity we need to cultivate in ourselves and beginning practitioners.

While it may be difficult to teach these skills from a textbook, we can deepen students’ relational sensibilities through the narrative methods of close reading and reflective writing, by demonstrating and role modelling effective communication in clinical encounters, and by valuing the role of practice wisdom in professional training.

As my year of relational drumming brought home to me first hand, there is a role for theatrical and musical improvisation in the training of practitioners. It is those hands-on experiences that foster the elusive, but invaluable, skills required for relational-centred care.